What oral nutritional supplements are there available

Juice type

Milkshake type

High energy powders

Soup type

High protein

Semi-solid and dysphagia ranges

What is enteral nutrition

1. Necessary when oral nutrition is not possible or insufficient to meet their requirements

2. Made up of a liquid mixture of all the needed nutrients

3. Given via a tube in the stomach or small intestine

4. Oral feeding is not possible, extended nil-by-mouth period is anticipated, an access device for enteral feeding should be inserted at time of surgery

Conditions like swallowing difficulty, ITU and unconsciousness

17

Describe what are the different enteral feeding routes and what important points should you consider

Jejunal tubes: Nasojejunal- most common- tube passed through nose and down into stomach- usually short term feeding for 4 weeks to provide support for patient to recover via illnessOrojejunal JejunostomyPEGJ (combined gastric and jejunal tube)

Other: caecostomy tube into caecum

Consider: - Current anatomy as bypasses, fistulae and drains may affect suitability of any enteral feeding tube for its intended purpose - Long term enteral tube access include PEG tubes that require considerable post insertion commitment and this should be borne in mind at the initial assessment

18

What are the four main routes of enteral administration and describe them

Nasogastric- Good for short term feeding and is less than 4 weeks- Soft and fine bore size- High aspiration risk so need to feed patient at 30-45 degree angle for at least 30 minutes

What are the complications of parenteral nutrition

Hepatic steatosis (infiltration of hepatocytes with fat)- Occurs within 1-2 weeks after starting PN- Reversible in patients on short term parenteral nutrition and typically resolves within 10-15 days - Limitation (<1g/kg/day) or remove fat content of parenteral nutrition or cyclical parenteral nutrition over 12 hours per day in long term PN patients

Cholestasis - Occurs within 2-6 weeks after starting PN - Indicated by progressive increase in bilirubin and an elevated serum alkaline phosphatase- Occurs due to no intestinal nutrients to stimulate hepatic bile flow- Bilrubin is > 5 to 10mg/dL due to hepatic dysfunction, consider stoping trace elements- can cause toxicity of manganase and copper